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Mixed Pain Can Be Discerned in the Primary Care and Orthopedics Settings in Spain: A Large Cross-Sectional Study

Ibor, Pedro J. PhD*; Sánchez-Magro, Isabel PhD; Villoria, Jesús MD; Leal, Ana BPharm; Esquivias, Ana PhD

doi: 10.1097/AJP.0000000000000491
Original Articles

Objectives: To assess the value of the concept of mixed pain by investigating its acceptance and interpretation by health care professionals and the differential characteristics in patients with mixed pain.

Materials and Methods: Data from 5024 patients with pain from 551 sites in Primary Care and Orthopedics settings were analyzed in this cross-sectional study. Pain characteristics, other factors influencing pain, health care–related data and health-related quality of life were summarized and compared among 3 groups of patients according to the type of pain (nociceptive, neuropathic, or mixed), as assigned by the investigators after considering the pathophysiological mechanisms involved.

Results: Pain was of mixed pathophysiology in most patients (59.3%; 95% confidence interval [CI], 59.2%-59.5%), followed by nociceptive (31.8%; 95% CI, 31.6%-32.0%) and neuropathic pathophysiology (8.9%; 95% CI, 8.8%-9.1%). Patients with mixed pain had pain in >1 site more frequently than the other groups. Spinal conditions was the attributed cause of pain in >80% of patients with mixed pain, whereas nonspinal osteoarthritis represented almost a third. Patients with mixed pain showed a greater clinical complexity than the remaining patients, as they reflected: more comorbidities, adverse psycho-social factors, health care resource utilization, undertreatment, and perceived difficulties in patient management, but less perceived effectiveness of treatments and a lower health-related quality of life.

Discussion: An independent category in the pathophysiological classification of pain is justified based on the differential characteristics of patients with mixed pain, although conceptualization of mixed pain should be improved. Increasing referrals to other specialists or implementing chronic pain management programs would seem advisable.

Conclusions: Patients with mixed pain showed more clinical complexity than patients with other types of pain. The consideration of mixed pain as an independent pathophysiological category may be justifiable on empirical clinical grounds.

*Integrated Health Care Centre Juan Llorens, Valencia

Medical Department, Grünenthal Pharma, S.A., Madrid

Department of Design and Biometrics, Medicxact, S.L., Alpedrete, Spain

P.J.I.: performed clinical evaluations of patients and supervised the study. I.S.-M. and A.E.: coordinated the study. J.V.: designed and performed the analysis of data and participated in drafting the manuscript.

Authors received funds from Grünenthal Pharma, S.A. for this research. P.J.I.: received consultancy fees from Grünenthal Pharma, S.A. I.S.-M. and A.E.: have a full-time job at Grünenthal Pharma, S.A. (Madrid, Spain). J.V.: received honoraria for drafting manuscripts for Grünenthal Pharma, S.A. (Madrid, Spain), Mundipharma, Pharmaceuticals, S.L. (Madrid, Spain) and Esteve, S.A. (Barcelona, Spain) and receives consultancy fees from Grünenthal Pharma, S.A. (Madrid, Spain), Danone, S.A. (Barcelona, Spain), Esteve, S.A. (Barcelona, Spain), Amadix, S.L. (Valladolid, Spain), Novartis Farmacética, S.A. (Barcelona, Spain), and Vivia Biotech, S.L. (Madrid, Spain). Funding for the logistic aspects of this research was provided by Grünenthal Pharma, S.A (Madrid, Spain). The remaining author declares no conflict of interest.

Reprints: Pedro J. Ibor, PhD, Pain Unit, Integrated Health Care Centre Juan Llorens, Juan Llorens 8, 46008 Valencia, Spain (e-mail: iborvidal@gmail.com).

Received September 13, 2016

Received in revised form January 31, 2017

Accepted February 8, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.